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It’s Not About the Teeth

January 5, 2015

Filed under: Leadership — Tags: , , — Barry @ 10:14 PM

Screen Shot 2014-12-18 at 12.22.40 PMEvery so often a patient enters my practice with a very interesting problem  The case that is pictured above is a good example that had me stuck. 

The patient came in with a toothache in the lower left quadrant.  She was convinced it was gum disease and wanted “laser surgery.”

Well, for those who know how I practice, I completed my comprehensive examination.  It revealed absolutely no gum disease.  What she thought was gum disease was a fistula associated with tooth #19.  But the tooth only had a small filling and I saw no reason to believe that caries was the cause.  I also noted that she had significant mobility on numbers 18 and 19.

Note the presence of occlusal disease…note the severe wear.

My biggest question was how she was able to wear down those front teeth…if she couldn’t get into the position to reach them.

What did I do?

Well, I am lucky enough to have some friends in high places.  I sent the photos and the records to twelve of my esteemed colleagues, members of my study club (that’s a plug for all study clubs).  We kicked it around for a couple of days and came up with a few possibilities.

Dentists are great for coming up with answers to tough technical problems.

I’m not going to give you the answer.  Most dentists love to solve these puzzles.  All I can tell you is that the answer was Sherlockian.

So I presented my case.

She was amazed and very happy that she didn’t need laser surgery because she could only imagine how much that would have cost.  I wondered how she would feel when I told her how much my restorative plan would cost.

The patient’s bigger problem, after the fistula, wasn’t dental…it was financial.  And it was real.  It was real to me and it was her number one priority in life.

She hadn’t worked in over two years.  She stayed home taking care of a disabled husband.  Things were difficult, like they are for many people these days.

I am not throwing this problem out to the dental community to see what types of solutions come back.  I am tired of all the “shoulds” I see on social media.

We have a big problem in this country.  Dentistry, with all of its technology and sophistication has the ability to fix just about anything these days…but the paradox is that less and less people are able to afford our advanced and innovative solutions.

As a community, we are better than that.  The dental community continues to get more and more fragmented.  Everyone has their own agenda yet we have a bigger more global problem that is growing everyday.

This is why there has to be a greater emphasis on leadership in our dental education.  I don’t know what the answer for this lady is…but it will be some combination of using my technical skills, and my leadership, planning and listening skills.  She doesn’t need a highly technical dentist to take care of her…just someone who cares enough about her.

I can fill this blog with case after case like this, most not as complex.  I see too many good people not getting dental work done because it is becoming unaffordable for them.  I would love to hear from you about what we can do as a community for this growing problem

If your solution lacks a sense of compassion, please put that stuff on Facebook or the other sophisticated dental sites.







  1. Barry, et. Al.

    It’s a matter of priorities. The gest restauraunts around here are packed. My boys’ busibess (autolenders) is moving a lot of product. Everyone has an iphone. What we have to offer, compared with the neophytes is something that people should be clamoring for, yet it’s not. Will the millenials have the same dental problems as the Boomers? No freakin’ way…they’ve been too coddled.

    So if there is one dentist in 100 that has th requisite training to deal with advanced icclusal disease today, and we are underutilized, what does that foretell for the future?

    We are not unaffordable. We are undervalued. And so, as we canter off into the sunset, we don’t need to treat everyone, only those who choose us, or those we choose to treat.

    Comment by Steve Markus — January 5, 2015 @ 11:01 PM

  2. Steve– I agree with everything you are saying…but that has been the age-old answer. Today’s middle class is really putting dentistry off. I have so many young patients who stayed away from dentists after college—they earn decent money but when faced with large dental bills they just can’t or won’t see their way through. The problem is growing say a young person with a family earns 50-60,000 and he and his spouse need $10,000 of dentistry (not that unheard of—and I’m not talking about cosmetic dentistry)…that’;s not iPhone or fancy restaurant numbers. That’s a significant percentage of their income. Without going “socialistic”—dentistry needs to think about these “social” issues.

    Comment by Barry — January 5, 2015 @ 11:24 PM

  3. Barry, I for one, am sick of the entitlement mentality. If you take care of your teeth, there’s no need for entitlement. If you don’t, and it’s not that hard, government shouldn’t be stepping in. Health care has become entitlement. Dental care is going to have to be a quality of life decision. People seem to have money for new cars and great dinners all the time. The answer probably lies more in the financing end, than the government intervention answer.

    Comment by steve — January 6, 2015 @ 8:22 AM

  4. Steve—Being a hard -ass, old school New Yorker—I agree with your assessment of entitlement issues. But—this lady wasn’t someone who felt entitled. She’s okay with her lot in life — she’s not looking for a free ride. She doesn’t drive a nice car…she looks like the hand she’s been dealt. That said—the post is more about a trend—the same trend that has taken the glut of Jaguars and Mercedes off the roads, the same trend that has effected every industry. It’s effecting dentistry—and we know how important dentistry is, right? We know how important it is just like cardiologists know how important not smoking is. So who will be the champions of dentistry? The economists? the insurance companies, the media? the marketers? Who speaks for dentistry’s real issues? That’s a;; I am asking.

    Comment by Barry Polansky — January 6, 2015 @ 10:30 AM

  5. So Barry, you are just coming to those realizations now huh? Some of us have seen it developing for the better part of a decade now, at least. It surely has been an undeniable spiraling downward of the dental world. There never has been any leadership, and it always has been every man for himself. Dentists did it to themselves, and they will never admit it. So insurance companies and corporate dental entities now have a firm and controlling grip over dentists. The pain has begun to be felt, such that more articles like this one from you have begun to show up. So much for being “recession proof” and being the “never has there been a better time to practice dentistry.” I wish it were not true, but it is true.

    Comment by Roger — January 6, 2015 @ 9:21 AM

  6. Roger–you are right. I haven’t just noticed it–I have seen it coming. The lady described in the post as well as a few other recent patients have made me think long and hard about some response this industry needs to take. I don’t have any answers–but I do believe the answers need sto come from the profession…not to just let others make decisions for us—according to THEIR self-interests.
    It’s interesting—Jospeh Campbell once said that most people respond to life with a “cliche’ of reponses.” I asked in the post for some imaginative– and creative responses—but I seem to be getting the same ol’ same ol’ cliches.

    Comment by Barry Polansky — January 6, 2015 @ 10:35 AM

  7. Thank you for the post Dr. Polansky. For me it seems to be more a conjunction of factors. Since the 2008 crisis the world economy isn’t the same. I’m not sure if will be someday again. I remember how affected I was at that time. People calling our office in order to cancel their ongoing treatments. People losing their jobs like that. It was crazy. Today we have the middle class still suffering, Dentistry becoming more expensive in general, the dental education is poorer these days — our colleagues doing and saying unrealistic things to the patients (patients normally come to my practice in a confusing state of mind because of what other dentists have said in regards to their needs)… All of this has affected my practice… even more than this. It’s been more demanding these days to lead people to what it’s best for them. It’s my perspective… just my experience. I have seen the light at the end of the tunnel though. Dr. Polansky your books can show us the way… It takes time to master it but it’s all worth it. One needs to believe first. Then let the magic begin. Thanks.

    Comment by Frederico — January 6, 2015 @ 9:41 AM

  8. Great comment Fred—you see with clear eyes. You are doing what’s necessary for you to survive and thrive in difficult times. This post purpose was to bring awareness to the industry that we may have more control over things — either individually or collectively. If things continue the way they are I am not sure that most dentists will have the ability to practice with the freedom and autonomy that they thought they would have when entering dentistry. I see so much self-promotion from individual dentists, CE programs, insurance companies, DMO’s—when does anyone stand back and ask —what is the best solution for the good of ALL concerned.

    Comment by Barry Polansky — January 6, 2015 @ 10:42 AM

  9. Nutshell: these are hard times for everyone; doctor and patient alike. Would that I could afford to take on every deserving case probono. Fortunately, Barry, our kids are grown and independent. I feel for those 20 years younger. Will institutions like Pankey, Dawson, Kois et al survive? I certainly hope so.

    I tried donating my time in a free clinic one day a week. If they were delivering that level of care and disregard for sterility and (more importantly) malpractice attorneys on a foreign mission, I would have gladly done it. Certainly the City of Camden was practically, a foreign mission. But strictly from a defensive standpoint, I couldn’t put my reputation and savings at risk.

    So we all should strive to bootstrap a neophyte dentist, and deliver care and cases with benificence in mind to those we consider deserving. The problem is there are too many people who would fall under the 50’s TV announcer’s opening query: “Would you like to be Queen, for a day (or King)?”

    These past many years I have been fortunate to stay afloat, and retain the employees who’ve been so loyal to me. I would have succumbed financially if these times had occurred 20 years ago.

    Comment by steve — January 6, 2015 @ 10:19 PM

  10. Thanks for the honesty Steve. I think that if all dentists would be as honest as that we could make some headway. Your last paragraph says it all—for me too. I really do feel for the younger dentists. I know some that feel betrayed that the profession isn’t offering them what was advertised. But I do believe that through education we can help the younger dentists create rewarding careers without succumbing to the pressures of the times.

    Comment by Barry — January 6, 2015 @ 11:21 PM

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